Sunday, December 14, 2008

Tobacco Control Advocates Argue that Smoking Should Be Banned Outside to Prevent Children From Seeing Smokers

In previous posts, I have inferred that anti-smoking groups' rationale for supporting widespread outdoor smoking bans includes the desire to prevent people from even seeing a smoker, but today, I can say that this inference is no longer speculative - it is confirmed. In a commentary published in this month's issue of BMJ, anti-smoking researchers from New Zealand argue explicitly that smoking should be banned in outdoor places in order to prevent children from merely seeing smokers in public.

In their commentary entitled "Should smoking in outside public places be banned? Yes," researchers from the Universities of Otago and Auckland argue that even though secondhand smoke may not be a problem in most outdoors locations, banning smoking is still justified because it prevents young people from seeing smokers.

According to the commentary: "Legislation to ban smoking indoors in public places is now commonplace, driven mainly by the need to protect non-smokers from exposure to secondhand smoke. A new domain for tobacco control policy is outdoor settings, where secondhand smoke is usually less of a problem. However, the ethical justification for outdoor smoking bans is compelling and is supported by international law. The central argument is that outdoor bans will reduce smoking being modelled to children as normal behaviour and thus cut the uptake of smoking."

The authors further argue that "the modelling of smoking can also be reduced by policies to restrict smoking in the presence of children. The entrenched nature of tobacco use in most societies, and its highly addictive qualities, require that such policies are far reaching. Smoking bans in many outdoor public areas are therefore an important additional approach to tobacco control."

The Rest of the Story

The argument presented in this commentary is not compelling in the slightest. The government must not restrict individual autonomy to the extent that it interferes with the right of adults to engage in lawful, unhealthy behaviors that may be observed by children. To do so would represent an extreme - and an unwarranted - intrusion into individual liberty and autonomy.

The same reasoning being used to support outdoor smoking bans would also support banning the consumption of alcohol in front of children. It would support banning adults from eating junk food, soda, or Vienna Fingers in front of children. It would support banning adults from playing hockey or engaging in any similar high-risk activities in front of children. Auto racing would certainly have to be banned in cases when any children were present. So would boxing. So would most movies, including those that are currently rated PG and PG-13.

The only compelling justification for government to restrict public behaviors from the sight of children is if those behaviors are viewed as morally reprehensible. For example, we protect children from seeing public nudity, public drunkenness, and public sex because there is a violation of public morals that we attribute to these behaviors. By putting smoking in the same category, anti-smoking advocates are basically arguing that smoking is an immoral behavior that needs to be regulated in the same way. I find this to be quite unfortunate, as public health practitioners should not be ascribing moral value to lawful, unhealthy behaviors.

I actually see this justification for outdoor smoking bans to be a dangerous one. Because once we start ascribing moral value to legal choices that people make which are truly not ethical decisions, we are in trouble. I certainly would hope that we won't start to view obesity this way, for example. But the same argument being advanced by these anti-smoking researchers would support interventions to ban fat people from the view of children in public.

Fortunately, Professor Simon Chapman has written a counter-point which argues that these outdoor smoking bans are unjustified because they are paternalistic. They are intended not to protect nonsmokers from secondhand smoke, but to discourage smokers from smoking.

Dr. Chapman writes: "Some are affronted by the mere sight of smoking. Others have an evangelical mission to use paternalistic "tough love" to help others quit. Prohibitions on personal behaviours can be justified by the right to interfere with the liberty of people to harm to others. But paternalism is most odious when used as a justification for limiting the choices that adults make when they put only themselves at risk. ... we do not evaluate the ethics of public health by the willingness of people to give up their autonomy, nor with the success of commandments to obey laws. The ethics here is about respect for the autonomy of individuals to act freely, providing their actions do not harm others."

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 25 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.